Hi, I found out about this site from your YouTube videos, which are very informative. I am in training as a sleep tech and have a few questions if you don't mind?

1) Observed a patient with what appeared to be CSR. He was not having centrals but just the wax/wane in the flow and resp. effort channels. My question, if the oxygen level drops > 4 % after the cycle, ( wave forms drops) do you count that as a hypopnea?

2) When do you apply ASV and what settings? I think the lab uses Respironics equipment, can you explain the different numbers and what to adjust for different events?
3) also were I am training, they do not have protocols in place, are you able to provide/suggest protocols for cpap/bipap titration(when to apply therapy/split for adults), ASV(respironics machine)?

Thanks a bunch!

According to AASM rules, or lab protocol? Our lab calls these Central Hypopneas, so they are counted as CSR if it lasts over 5 minutes straight.

Our lab requires an order for it. We only run ASV recording by themselves and with an order. These are done after some diagnostic long term APAP home tests are run to see if the CSR resolves on its own (CSR that was seen in the lab). It often does and they just stick with APAP or standard Bilevel.

IPAP max is set at the max, EPAP min is set for 4, EPAP max is set for 15, PS min is set as low as it will go...0, and PS max is set as high as it will go. The rate is set for auto. That's it. These adjust breath by breath, so leaving it wide open like this enables this highly advanced PAP machine to do its job. If you see events with and ASV....wait, then do nothing. The worst thing a technician can do is change a setting with an ASV. All the learning that the machine has done with the patient is reset. Just set it wide open and let it work.

I am able to provide suggestions....for a crapload of money. Advice to patients is free....advice to labs for tedious and mind numbing policy and procedure manuals is going to cost them the money version of the blood sweat and tears that I have in developing them. Sorry!

A hint is that much of that is out of your control and set by the payers.

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TheLankyLefty
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